ATI: Nursing Leadership & Management Chapters 1-5 San Jacinto College - Central Campus RNSG 2121 Chapter 1: Managing Client Care Leadership Styles 1. Authoritative 2. Democratic 3. Laissez-faire A. Makes decisions for the group; motivates by coercion; communication via chain of command B. Makes very few decisions; does little planning; motivation is largely responsibility of individual staff members; communication occurs up and down chain of command C. Includes group in decisions; motivation by supporting staff achievements; communication occurs up and down chain of command Characteristics of Leaders ❖ ❖ ❖ ❖ ❖ ❖ ❖ Initiative Inspiration Energy Positive attitude Communication skills Respect Problem-solving and critical-thinking skills Types of Leaders A. Inspires others to follow by modeling a 1. Transformational Leader 2. Transactional Leader 3. Authentic Leader strong moral code B. Empowers and inspires followers to achieve a common vision C. Focuses on immediate problems, maintaining the status quo and using rewards to motive Emotional Intelligence ❖ Nurse must perceive and understand own emotions and the emotions of the client and family ❖ Important characteristic of an effective leader ➢ Insight into emotions of team members ➢ Encourages constructive criticism ➢ Refrains from judgement in controversial or emotionally-charged situations until facts are gathered 5 Functions of Management 1. Planning 2. Organizing 3. Staffing 4. Directing 5. Controlling Critical Thinking, Reasoning, & Judgement ❖ Includes interpretation, analysis, evaluation, inference, and explanation ❖ Mental process used when analyzing elements of clinical situation ❖ Decision made regarding a course of action based on analysis of data Prioritization ❖ Must reset to meet needs of multiple clients and maintain safety ❖ Priorities include: ➢ Which client is seen first ➢ When assessments are completed ➢ When/what interventions are provided first ➢ When other components of care to be completed Concepts of Prioritization ❖ Systemic before local (“Life before limb”) ❖ Acute before chronic ❖ Actual problem before potential ❖ Listen carefully and don’t assume ❖ Disability ❖ Exposure Maslow’s Hierarchy of Needs Time Management ❖ Organize care according to client needs and priorities ➢ 1. Immediate concerns ➢ 2. Time-sensitive care ➢ 3. Care that must be done by end of shift ➢ 4. Delegated care ❖ Time-saving strategies and avoid time-wasters Assigning, Delegating, and Supervising 1. Assigning 2. Delegating 3. Supervising A. Process of directing, monitoring, and evaluating the performance of tasks by another member of the healthcare team B. Process of transferring authority and responsibility to another team member to complete a task, while retaining accountability C. Transferring the authority, accountability, and responsibility of client care to another member of the healthcare team Delegation Video https://link.videoplatform.limelight.com/media/?mediaId=2d054fe9b0144aa9b331906517c1bfee&width=540 &height=321&playerForm=LVPPlayer&embedMode=html&htmlPlayerFilename=limelightjs-player.js Staff Education, Orientation, & Socialization ❖ Involvement in orientation, socialization education, and training of fellow healthcare workers ❖ Quality of care is directly related to education and level of competency ❖ Orientation helps new staff translate knowledge, skills, and attitudes into practice ➢ Introduced to philosophy, mission, and goals of organization ➢ Introduced to unit ❖ Socialization refers to learning a new role and values/culture of the group Quality Improvement & Peer Review ❖ Process used to identify and resolve performance deficiencies ➢ Outcome Indicators ➢ Structure Indicators ➢ Process Indicators ❖ Formal system for conducting performance appraisals ➢ Data should be collected to ensure unbiased evaluations Conflict Resolution ❖ Result of opposing thoughts, ideas, feelings, behaviors, values, opinions, or actions ➢ 1. Latent conflict ➢ 2. Perceived conflict ➢ 3. Felt conflict ➢ 4. Manifest conflict ❖ Problem-solving and negotiation Negotiation Strategies ❖ ❖ ❖ ❖ ❖ ❖ Avoiding/withdrawing Smoothing Competing/coercing Cooperating/accommodating Compromising/negotiating Collaborating Assertive Communication ❖ ❖ ❖ ❖ Expression in direct, honest, and nonthreatening way Acknowledges and deals with conflict Recognizes others as equals Elements of assertive communication NCLEX Question #1 A nurse enters the room of a client and finds the client lying on the floor. Which of the following actions should the nurse take first? A. B. C. D. Call the provider Ask a staff member for assistance getting the client back in bed Inspect the client for injuries Instruct the client to ask for help if they need to get out of bed NCLEX Question #2 A PN is ending their shift reports to the RN that a newly hired AP has not calculated the intake and output for several clients. Which of the following actions should the RN take? A. B. C. D. Complete an incident report Delegate this task to the PN Ask the AP if they need assistance Notify the nurse manager Prioritization, Delegation, Assignment Practice Chapter 2: Coordinating Client Care Collaboration ❖ Qualities for effective collaboration ❖ Nurses’ role in collaboration: ➢ Coordinate interprofessional team ➢ Holistic understanding of client ➢ Continuity of care ➢ Provide information during rounds ➢ Provide link to postdischarge resources Factor Affecting Collaboration ❖ Hierarchical influence on decisionmaking ❖ Behavioral change strategies ❖ Planned change ❖ Lewin’s change theory ❖ Stages of team formation ❖ Generational differences Case Management ❖ ❖ ❖ ❖ Collaboration with healthcare team in acute and post-acute settings Goal is to avoid fragmentation of care and control cost Critical/clinical pathways Continuity of care Consults, Transfers, & Discharge ❖ Consultants provide expert advice in a particular area ➢ Nurses can initiate consults/notify provider of need ➢ Incorporates consultants’ recommendations into plan of care ❖ Referrals are formal requests for a service by another care provider ➢ May include need for special equipment, specialized therapists, and/or care providers ❖ Transfers may be between units or facilities ➢ Handoff communication is key to continuity of care ❖ Discharge planning begins on admission NCLEX Question #1 A nurse is preparing to transfer a client who is 72 hr post-op to a long-term care facility. Which of the following information should the nurse include in the transfer report? (Select all that apply) A. B. C. D. E. Type of anesthesia used Advance directives status Vital signs on day of admission Medical diagnosis Need for specific equipment NCLEX Question #2 A nurse is assisting with the discharge planning for a client. Which of the following actions should the nurse take? (Select all that apply) A. B. C. D. E. Determine need for home medical equipment Provide a list of all medications the client received in the facility Obtain printed instructions for medication self-administration Provide the family with a list of community agencies that can provide assistance Discuss the importance of attending follow-up appointments NCLEX Question #3 A nurse is caring for a client who has chest pain. The client says, “I am going home immediately.” Which of the following actions should the nurse take? (Select all that apply) A. B. C. D. E. Notify the client’s family of their intent to leave the facility Document the client’s intent to leave the facility against medical advice (AMA) Explain to the client the risks involved if they choose to leave Ask the client to sign a form relinquishing responsibility of the facility Prevent the client from leaving the facility until the provider arrives NCLEX Question #4 A case manager is discussing critical pathways with a group of newly hired nurses. Which of the following statements indicates understanding? A. “The time to fill out the pathways often increases the cost of care.” B. “The pathway shows an estimate of the number of days the client will be hospitalized.” C. “Deviance from the pathway is a sign of improved care quality.” D. “The pathway included information about the client’s history.” Chapter 3: Professional Responsibilities Client Rights ❖ ❖ ❖ ❖ Be informed about all aspects of care and take an active role in decisions Accept, refuse, or request modification to the plan of care Care delivered by respectful and competent individuals Refusal of treatment ➢ Clients must sign document stating they understand risks ➢ AMA procedure Client Rights Video https://link.videoplatform.limelight.com/media/?mediaId=0abdd0d615684b5db41dd0c32f31b6f7&width=540 &height=321&playerForm=LVPPlayer&embedMode=html&htmlPlayerFilename=limelightjs-player.js Advocacy ❖ Ensure clients have information necessary to make informed decisions ❖ Must act on clients’ behalf, even if the nurse disagrees ❖ Common situations for advocacy: ➢ End-of-life decisions ➢ Access to health care ➢ Protection of client privacy ➢ Informed consent Informed Consent ❖ Reason for treatment; risks; alternatives; and risks if refusal ❖ Most nursing care is implied consent ➢ E.g. patient holds out their arm for a blood pressure to be taken ❖ Invasive procedures require written consent ❖ The provider obtains informed consent ➢ Nurses witness that the patient received and understood the information, and notifies the provider if the client has questions Who can sign consent forms? ❖ Competent adults & emancipated minors ❖ Client must understand the information and be able to communicate with the healthcare provider ➢ Medical interpreter may be used ❖ Parent of minor ❖ Legal guardian ❖ Court-specified representative ❖ Health care surrogate ❖ Spouse or closest available relative Advance Directives ❖ Living will ➢ Expresses the client’s wishes regarding treatment in the event the client becomes incapacitated ❖ Durable power of attorney for health care ➢ Designates a healthcare surrogate for a client who is unable to make decisions on their own ❖ DNR/DNI Confidentiality & Information Security ❖ HIPAA ➢ Obtain a copy of their record ➢ Submit request to amend erroneous or incomplete information ➢ Written information on how information will be used/shared ➢ Privacy and confidentiality ❖ Keep workstations secure ❖ Inappropriate use of social media Unintentional & Quasi-Intentional Torts 1. Negligence 2. Malpractice 3. Libel 4. Slander A. Practice that does not meet expected standards of care and place client at risk for injury B. Professional negligence C. Defamation with written word D. Defamation with spoken word Intentional Torts 1. Assault 2. Battery 3. False Imprisonment A. Physical contact with a person that involves injury or offensive contact B. Conduct that makes another person fearful and apprehensive C. Competent person, not at risk for injury to self or others, is confined against their will Standards of Care ❖ Texas State BON Practice Act ➢ https://www.bon.texas.gov/laws_and_rules_nursing_practice_act.asp ❖ Facilities also have policies/procedures to guide care Legal Concerns ❖ Impaired coworkers ❖ Mandatory reporting ➢ Abuse ➢ Communicable disease (full list via CDC) ❖ Verbal prescription orders Disruptive Behavior & Ethics ❖ Incivility ❖ Lateral violence ❖ Bullying ❖ ❖ ❖ ❖ ❖ ❖ Autonomy Beneficence Fidelity Justice Nonmaleficence Veracity NCLEX Question #1 A nurse manager is observing the actions of a nurse they are supervising. Which of the following actions by the nurse requires the nurse manager to intervene? (Select all that apply) A. B. C. D. E. Reviewing the health care record of a client assigned to another nurse Making a copy of a client’s most current laboratory results for the provider during rounds Providing information about a client’s condition to hospital clergy Discussing a client’s condition over the phone with an individual who has provided the client’s information code Participating in walking rounds that involve the exchange of client-related information outside clients’ rooms NCLEX Question #2 A nurse witnesses an assistive personnel (AP) they are supervising reprimanding a client for not using the urinal properly. The AP threatens to put a diaper on the client if the urinal is not used more carefully next time. Which of the following torts is the AP committing? A. B. C. D. Assault Battery False imprisonment Invasion of privacy NCLEX Question #3 A nurse is serving as a preceptor to a newly licenced nurse and is explaining the role of the nurse as advocate. Which of the following situations illustrates the advocacy role? (Select all that apply) A. B. C. D. Identifying that a client understands what is done during a cardiac catheterization Discussing treatment options for a terminal diagnosis Informing members of the healthcare team that a client has DNR status Reporting that a health team member on the previous shift did not provide care as prescribed E. Assisting a client to make a decision about their care based on the nurse’s recommendations Chapter 4: Maintaining a Safe Environment Culture of Safety ❖ ❖ ❖ ❖ ❖ ❖ Promotes openness and error reporting Service occurrences Near misses Serious incidents Sentinel events Failure to rescue Handling Infectious and Hazardous Materials ❖ ❖ ❖ ❖ ❖ Infection control Standard precautions Hand hygiene Proper equipment Safety Data Sheets Prevention of Falls ❖ Physiologic changes in elderly ❖ Decreased visual acuity ❖ Generalized weakness ❖ Orthopedic problems ❖ Urinary frequency ❖ Gait and balance problems ❖ Cognitive dysfunction What can we do to prevent falls? Seizure Precautions & Restraints ❖ Seizures ➢ Close to nurses’ station ➢ Maintain patent IV ➢ Ensure rescue equipment at bedside ❖ Restraints ➢ Follow policy for use of restraints/seclusion ➢ Always start with least restrictive interventions ➢ PRN orders for restraints are not permitted Home Safety & Ergonomics ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ Refer to text p. 55-57 for age-specific safety concerns Plan activities and ask for help Maintain good posture and exercise regularly Use smooth movements Avoid repetitive movements Avoid twisting or bending at the waist Keep object close to the body Use assistive devices safely NCLEX Question #1 A home health nurse is assessing the safety of a client’s home. The nurse should identify which of the following factors as increasing the client’s risk for falls? (Select all that apply) A. B. C. D. E. F. History of previous fall Reduced vision Impaired memory Takes rosuvastatin Uses a night light Kyphosis NCLEX Question #2 A nurse is observing a newly licensed nurse and an assistive personnel (AP) pull a client up in bed using a drawsheet. Which of the following actions by the newly licensed nurse indicates an understanding of this technique? A. B. C. D. The nurse stands with both feet together The nurse uses their body weight to counter the client’s weight The nurse’s feet are facing inward, toward the center of the bed The nurse rotates the waist while pulling the client upward NCLEX Question #3 A nurse on an acute care unit is caring for a client following a total hip arthroplasty. The client is confused, moving the affected leg into positions that could dislocate the new hip joining, and repeatedly attempting to get out of bed. After determining that restraints are indicated, which of the following actions should the nurse take? (Select all that apply) A. B. C. D. E. Secure the restraint to the frame of the bed Get a prescription for restraints from the provider Have a family member sign consent for restraints Ties restraints to the side rail using a double knot Ensure that only 1 finger can be inserted between restraint and the client Chapter 5: Facility Protocols Reporting Incidents ❖ Unexpected or unusual incidents that affected a client, employee, volunteer, or visitor ➢ Medication errors ➢ Procedure/treatment errors ➢ Equipment-related errors ➢ Falls/injuries ➢ Threat made to client or staff ❖ Not placed nor mentioned in healthcare record Disaster Planning & Emergency Response ❖ ❖ ❖ ❖ ❖ Disaster v. mass casualty incident Internal v. external emergencies Hospital Incident Command System (HICS) Each facility has an action plan, often with assigned teams of staff Triage system in place for MCI’s ➢ Red (I), Yellow (II), Green (III), Black (IV) Triage System for Mass Casualty Incidents Types of Emergencies ❖ ❖ ❖ ❖ ❖ ❖ Biological incidents Chemical incidents Hazardous materials Nuclear incidents Explosive incidents Radiological incidents Security Plans ❖ Preventative, protective, and response measures ➢ Admission of potentially dangerous clients ➢ Vandalism ➢ Infant abduction ➢ Information theft ❖ R.A.C.E. & P.A.S.S. NCLEX Question #1 A nurse discovers that a client was administered an antihypertensive medication in error. Identify the appropriate sequence of steps that the nurse should take using the following actions A. B. C. D. E. Call the provider Check vital signs Notify the risk manager Complete an incident report Instruct the client to remain in bed until further notice NCLEX Question #2 A nurse manager is explaining the use of incident reports to a group of nurses in an orientation program. Which of the following information should the nurse manager include? (Select all that apply) A. B. C. D. E. A description of the incident should be documented in the client’s health record The client should sign as a witness on the incident report Incident reports include a description of the incident and actions taken A copy of the incident report should be placed in the client’s health care record The risk management department investigates the incident
